insights

                                                                                                                                                                                                                    Read time 5 minutes

Healthcare providers are dedicated people who tend to focus on their patients and work, often to the detriment of their own well-being. Practitioners are encouraged to reflect on their own personal health-related needs in order to protect their valuable coping and caregiving abilities, especially now as pandemic-related pressures of adjusted practice procedures, personal safety, and high-quality patient care under strained conditions continue.^1,2

Burnout: Statistics and Support

Burnout is a recognized syndrome characterized by physical and emotional exhaustion due to chronic workplace stress.³ In addition, burnout can include feelings of ineffectiveness, a loss of meaning at work, and reduced personal accomplishment.⁴

Physician burnout is an important issue that has been investigated and monitored frequently in the past and continues to be highly visible and concerning due to the extended strain on healthcare professionals during the ongoing COVID-19 pandemic. In the 2021 Medscape National Physician Burnout and Suicide Report, 42% of the 12,339 responding physicians in over 29 specialties said they felt burnt out (36% of men, 51% of women), 20% reported feeling depressed, 13% reported having thoughts of suicide, and 1% reported a suicide attempt.⁵ The demanding pandemic response may have affected some specialties more than others, with critical care physicians reporting the highest burnout at 51%.⁵ Top factors contributing to burnout included too many bureaucratic tasks and long hours at work.⁵ The top three coping mechanisms reported were exercise, talking with friends or family members, and isolation from others.⁵ When asked what could help the most to reduce burnout, the top responses included increased compensation to avoid financial stress, more manageable work and schedules, and a greater respect from employers, colleagues, and staff.⁵

Contributing Factors and Consequences

Scientific reviews and yearly studies highlight not only statistics of physician burnout and gaps in knowledge about the situation, but they also attempt to identify the root causes, contributing factors, and impact of burnout in the healthcare community. Recent reporting indicates a need to support the resilience of individual physicians as well as organizations to address problems and systemic challenges within the healthcare culture and medical industry that may contribute to burnout.^4,6

Recent literature suggests that sleep disruption, sleep deprivation, and circadian misalignment may contribute to physician burnout.⁷ Loss of social connectedness within the healthcare community is also highlighted as a potential factor, with intervention and support on an institutional level suggested to enhance overall community and well-being.⁸ In addition, many practitioners continue to cope with pandemic-related anxiety, psychological distress, and depression,^9-11 which may contribute to workplace stress.

Consequences of burnout, compassion fatigue, and distress may range from personal crisis to suboptimal patient care practices. A 2020 cross-sectional observation study suggested that physician burnout may negatively affect patients’ experience of care.¹² In the study, 244 physicians rated their level of burnout on a five-point scale, and these results were analyzed with responses from over 30,000 experience-related surveys completed by patients who had seen those physicians.¹² Results indicated that a one-level increase in burnout was associated with a 0.43 level decrease in an adjusted patient-provider communication experience score.¹²

Resources and Support: From Hobbies and Meditation to PPE

How do clinicians care for themselves? What are the resources for supporting work-life balance, essential self-care, and perseverance during times of sustained stress? Just as with patients, no single answer will work for everyone. Effective strategies for personal self-care include prioritizing close relationships and maintaining a healthy lifestyle by ensuring adequate sleep, regular exercise, fostering hobbies, practicing mindfulness and meditation, and pursuing spiritual development.¹³ Recent studies have suggested positive impacts from these self-care approaches:

• A 2020 nonrandomized pilot study of 34 physicians who had reported having anxiety suggested that the use of an app-based mindfulness program may reduce anxiety associated with burnout by as much as 48% within the first month.¹⁴
• Further, a 2020 randomized clinical trial pilot of 88 physicians found that participants who received only six sessions of professional coaching had a significant reduction in emotional exhaustion and overall burnout and had improved resilience and quality of life.¹⁵

During the heightened stress and potentially critical conditions experienced by many healthcare professionals, self-care tools are important for resilience and coping endurance.¹ The American Medical Association (AMA) has updated its suggestions for taking care of caregivers to include building a resilient healthcare organization, monitoring workload redistribution, assessing physician stress levels, reviewing institutional policy and personal protective equipment (PPE) recommendations, and providing emotional and mental well-being resources.¹⁶ The AMA website even offers a free meditation and sleep app for practitioners due to the potential positive impacts of adequate rest and mindfulness practices.¹⁶

Conclusion

Large patient volumes, emergency situations, and other life factors may be outside of a clinician’s control; however, implementing personal self-care practices for the protection and maintenance of valuable coping and caregiving abilities is essential for continuing the delivery of quality patient care and ultimately improving patient outcomes. Functional medicine clinicians continue to improve the quality of life for many patients. Lifestyle factors, the fundamental components of functional medicine, are key factors of health for both patients and clinicians. Indeed, one of the core lessons in the practice of functional medicine is to care for yourself while also caring for your patients. In sum, when personal satisfaction is increased, so too is professional satisfaction. Not only will your patients experience better care, you will feel more satisfaction with your practice and may be less likely to experience burnout.

Find out more about prioritizing clinician self-care at IFM’s Applying Functional Medicine in Clinical Practice (AFMCP), and network with other clinicians focused on promoting health, modeling lifestyle change, and working toward a healthier population of patients and clinicians.

Related Podcast & Articles:

Clinician Burnout: Coping From a Personal and Practice Standpoint

Telemedicine, Legal Concerns, and Your Functional Medicine Practice

A Systems Biology Approach, Physician Burnout, and Functional Medicine

References

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2. Shanafelt T, Ripp J, Trockel M. Understanding and addressing sources of anxiety among health care professionals during COVID-19 pandemic. JAMA. 2020;323(21):2133-2134. doi:10.1001/jama.2020.5893
3. Burn-out an “occupational phenomenon”: international classification of diseases. World Health Organization. Published May 28, 2019. Accessed February 18, 2021. https://www.who.int/mental_health/evidence/burn-out/en/
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5. Kane L. ‘Death by 1000 cuts’: Medscape national physician burnout & suicide report 2021. Medscape. Published January 22, 2021. Accessed February 23, 2021. https://www.medscape.com/slideshow/2020-lifestyle-burnout-6012460
6. Carrieri D, Pearson M, Mattick K, et al. Interventions to minimize doctors’ mental ill-health and its impacts on the workforce and patient care: the Care Under Pressure realist review. Health Serv Deliv Res. 2020;8(19). doi:10.3310/hsdr08190
7. Kancherla BS, Upender R, Collen JF, et al. Sleep, fatigue and burnout among physicians: an American Academy of Sleep Medicine position statement. J Clin Sleep Med. 2020;16(5):803-805. doi:10.5664/jcsm.8408
8. Southwick SM, Southwick FS. The loss of social connectedness as a major contributor to physician burnout: applying organizational and teamwork principles for prevention and recovery. JAMA Psychiatry. 2020;77(5):449-450. doi:10.1001/jamapsychiatry.2019.4800
9. Pearman A, Hughes ML, Smith EL, Neupert SD. Mental health challenges of United States healthcare professionals during COVID-19. Front Psychol.2020;11:2065. doi:10.3389/fpsyg.2020.02065
10. Chew NWS, Lee GKH, Tan BYQ, et al. A multinational, multicentre study on the psychological outcomes and associated physical symptoms amongst healthcare workers during COVID-19 outbreak. Brain Behav Immun. 2020;88:559-565. doi:10.1016/j.bbi.2020.04.049
11. Pappa S, Ntella V, Giannakas T, Giannakoulis VG, Papoutsi E, Katsaounou P. Prevalence of depression, anxiety, and insomnia among healthcare workers during the COVID-19 pandemic: a systematic review and meta-analysis. Brain Behav Immun. 2020;88:901-907. doi:10.1016/j.bbi.2020.05.026
12. Chung S, Dillon EC, Meehan AE, Nordgren R, Frosch DL. The relationship between primary care physician burnout and patient-reported care experiences: a cross-sectional study. J Gen Intern Med. 2020;35(8):2357-2364. doi:10.1007/s11606-020-05770-w
13. Sanchez-Reilly S, Morrison LJ, Carey E, et al. Caring for oneself to care for others: physicians and their self-care. J Support Oncol. 2013;11(2):75-81. doi:10.12788/j.suponc.0003
14. Roy A, Druker S, Hoge EA, Brewer JA. Physician anxiety and burnout: symptom correlates and a prospective pilot study of app-delivered mindfulness training. JMIR Mhealth Uhealth. 2020;8(4):e15608. doi:10.2196/15608
15. Dyrbye LN, Shanafelt TD, Gill PR, Satele DV, West CP. Effect of a professional coaching intervention on the well-being and distress of physicians: a pilot randomized clinical trial. JAMA Intern Med. 2019;179(10):1406-1414. doi:10.1001/jamainternmed.2019.2425
16. Caring for our caregivers during COVID-19. American Medical Association. Updated January 25, 2021. Accessed February 23, 2021. https://www.ama-assn.org/delivering-care/public-health/caring-our-caregivers-during-covid-19